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Fromm-Reichmann, F. (1947). Problems of Therapeutic Management in a Psychoanalytic Hospital. Psychoanal Q., 16:325-356.

(1947). Psychoanalytic Quarterly, 16:325-356

Problems of Therapeutic Management in a Psychoanalytic Hospital

Frieda Fromm-Reichmann, M.D.

Psychoanalytic therapy has been applied in the treatment of hospitalized psychotics for about twenty years. Since then, there has been much thought and discussion about how to change and adapt conventional state hospital management to the requirements of a psychoanalytic hospital.

We are still far from having all the answers; hence I feel that the best I can do is to outline some of the questions with the tentative answers which have emerged so far, from any discussions between our staff members, from the exchange of opinion among the psychoanalytic hospitals of the country, and from the literature which has been published on the subject. This may contribute to further clarification of administrative psychotherapy, and may provoke further constructive discussion.

I

The psychoanalyst who works with psychotics in a psychoanalytic hospital realizes more than his colleagues in other mental hospitals that undue curtailment of the patients' freedom i.e., misuse of authority by previous authoritative figures especially by the parents in the patients' childhood and by their later representatives in society, is most frequently among the reasons for the rise of mental disturbance. Therefore, he is inclined to give the patients as much freedom and as many privileges as possible, and he will try to force on them the least number of regulations and restrictions. However, the hospitalized psychotic's conception of, and need and desire for freedom is not identical with that of the healthy person.

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